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Visible Scars from Lower Blepharoplasty?

I'm considering various procedures to eliminate thin, sagging skin that I'm starting to under my eyes. I had heard that lower blepharoplasty left no visible scars - that the scar is inside the lower eyelid. However, everyone having gone through it here says they now have visible scars. Can someone shed some light on this? Thanks in advance! - michelle

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13 Doctor Answers | Asked by newnikita in new york

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Lower eyelid blepoharoplasty: the incision options

You are discussing two different approaches to the lower eyelid: The transconjuntival approach: the incision is made on the inside lining of the eyelid across the conjunctiva hence the name transconjunctival approach. This is used to remove or rearrange the fat but does not treat the skin. Therefore, it tends to be performed in young individuals or those with minimal skin excess or muscle redundancy. The subciliary approach: the incision is usually placed immediately below the lower eyelid... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Loose skin under the eyes

Loose skin under the eyes is a difficult problem. A transconjunctival blepharoplasty (removal of the fat from the inside of the eye) can actually make the loose skin worse. A TCA or laser peel often helps somewhat but is typically not powerful enough to tighten the skin significantly. Incisions below the eye (subciliary incision) leave scars that can be visible and in fact are visible in almost all patients, if you look closely enough. Also, removal of skin from below the eye can alter... more

Lower lid scars

The lower lid rejuvenation process can be addressed by a trans-cutaneous approach, which is the route that places the incision just beneath the lashes. The other route is the transconjunctival approach which simply removes the fat from the inside of the lower lid with out any visible skin incisions. The transcunjunctival is not for every one and most times requires some level of skin tightening. This can be in the form of laser skin tightening or just a pinch excision. In general the... more

Lower blepharoplasty may result in barely visible scars

Lower eyelid blepharoplasty can be performed in a number of ways. Some approaches allow for an incision through the inside of the lower eyelid. In this situation, no visible scarring will be seen. Other approaches, however, require an incision through the skin just beneath the lower lashes. In this situation, a visible scar will be present. This scar however tends to be barely perceptible and easily camouflaged with normal eyeliner. The type of procedure most appropriate, depends... more

Scars after blepharoplasty

In order to address both contour and skin excess of the lower lids, an incision is placed right below the lash line. Because the skin is very thin here, this line heals up very well without leaving aesthetic issues. Inside the eye incisions for a transconjunctival eyelid lift sometimes leads to additional skin laxity. In order to prevent this, some surgeon like laser resurfacing in combination with this technique. If you have significant skin laxity to begin with, this may not be enough,... more

Scars and lower lid blepharoplasty

Thanks for your question - You're describing two different approaches for blepharoplasty - One is subciliary (meaning below the eyelash) and the other is transconjunctival (through the conjunctiva at the inside of the lid). The transconjuntival approach only addresses the contents of the tear trough area. It cannot correct excess skin. This technique can be used with other techniqes (such as laser) to tighten the skin and avoid scars. I hope this helps.

Subciliary for skin removal

If you have sagging skin you will need a small incision under the eye lashes. This incision usually heals very well and leaves behind a very thin scar that is hard to see. The transconjuctival incison allows removal or redraping of excess fat pockets. It does not allow removal of excess skin.

If you have extra skin you will have a scar

It's true that lower lid blepharoplasties can be done in many different ways. The transconjunctival or incision inside the lower lid is used when only fat removal or fat redraping is needed. However, if any skin needs to be removed or if the lid needs tightening than a skin incision is made. This incision is just under the eyelashes and extends into the lateral crease a few millimeters. The scar is very imperceptible when healed. See several Board Certified Plastic Surgeons to find... more

Not likely a good candidate for transconjunctival bleplaroplasty

There are very few patients who are great candidates for only a transconjunctival blepharoplasty. This procedure either removes bulging fat from the inside of the eyelid or at times allows for repositioning of the fat. Only younger patients are usually good candidates for the procedure. It would not be the procedure of choice for thin eyelid skin. An external lower eyelid incision, when placed in the appropriate position will blend in to the natural lines of the face and be barely... more

You can have transconjunctival blepharoplasty

A transconjunctival incision is an incision that is made inside the lower eyelid that avoids an external incision. The best candidates for this are people that don't need to remove skin and just need fat that is bulging taken out. If you are looking to remove extra skin as well, an external incision is unavoidable in a lower blepharoplasty. The other option is filling up the area under the eye with a filler or fat injections. Fat injections last much longer than commercially prepared... more

Philip Young, MD

6 reviews

Bellevue Facial Plastic Surgeon

I'm sorry that you are confused

I had a lower (and upper) eye lid blepharoplasty 26 years ago and it was one of the best things I ever did, other than marry my wife. While there is a scar on my lower lids, as I had the outside incision, you are welcome to see for yourself that it is not visible. The incision behind the eyelid has become popular and can be done in the majority of cases where puffiness is the primary problem. External skin tightening can be achieved with topical treatments instead of skin excision.... more

Eyelid scars are generally not a problem.

Hello Michelle, Lower eyelid surgery can be tricky, but not because of the scars. The exact technique (there are several) must be individualized according to the anatomy. With some techniques (maybe 30% of patients), I do make an incision just under the lashes, but eyelid skin is very thin, and if the surgery is done correctly, the scars are very faint. You can see them if you look for them, but they are just not an issue, even in men with no make up. The tricky part is getting the... more

Transconjunctival blepharoplasty and fractional laser resurfacing may tighten loose eyelid skin

Fractional ablative laser skin resurfacing can tighten loose skin on the lower eyelid if the eyelid support is good and the lid is not lax. Most people benefit from the transconjunctival blepharoplasty, which uses an incision on the inside of the lower eyelid and thus does not leave a visible scar. During this procedure eye bags can be removed and dark circles plumped by a technique called fat repositioning or fat grafting. These techniques have become popular because the external incision... more